Long-term results after proximal thoracic aortic redo surgery

Abstract

Objective: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. Methods:We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed.Results: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome-(ROC 0.786, 95%CI 0.64-0.93) as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06). Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79) but not advanced age (OR 2.46, 95%CI 0.48-12.66) as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months). One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%.Conclusions: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

“…The increased risk of reoperative surgery on the aortic arch underlines the importance of initially considering a more distal extent of resection at the first operation. 20,30,31 Patients with descending extension of aortic pathology had significantly worse survival in the first year, but no significant difference in late survival. Almost half (45.1%) of these patients had dissection.…”

Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology

“…As many of these underwent prior repair of acute type A aortic dissection, the question arises whether a more extensive surgical approach during primary surgery would have prevented the need for redo surgery. It is our policy to perform root replacement during primary surgery if the retrograde component of the dissection involves more than the non-coronary sinus in order to prevent the need for late reoperation in this segment [13]. Regarding the extent of arch surgery, our own data indicate that if the primary entry tear is eliminated during surgery for acute type A aortic dissection, the need for later arch or thoraco-abdominal reoperation is very low.…”

Correlation of Coagulopathy and Frozen Elephant Trunk Use in Aortic Arch Surgery: A Systematic Review and Meta-analysis

“…Apart from graft sizing, several FET devices are available, [67][68][69][70][71] and their usage in clinical practice is evolving so that studies for outcomes of such devices are being increased in literature. 51 The globally used tetrafurcate Thoraflex Hybrid ® stent-graft provides separate reimplantation of supra-aortic vessels, an easier anastomosis to the distal aortic arch, and radio-opaque markers in the stented part.…”